We know what works. Let's tweak the plan

Sunday

Nov 23, 2008 at 2:00 AM

While the recent news on homelessness emanating from downtown Hyannis has been difficult, there is no need for an ongoing polarization. On Cape Cod, there is a record of political will, resources, and results that can overcome such gridlock.

PHILIP F. MANGANO

While the recent news on homelessness emanating from downtown Hyannis has been difficult, there is no need for an ongoing polarization. On Cape Cod, there is a record of political will, resources, and results that can overcome such gridlock.

The Cape has been blessed in significant ways in the past few years. That assures us that the current debate is resolvable in a partnership of all perspectives and in visible results on the streets.

First the blessings. Back in 2004 political leaders on the Cape came together with community stakeholders to create a 10-Year Plan to solve the homelessness of those who are the most vulnerable and disabled. Researchers told us those who live on the streets or languish in the shelters are experiencing chronic homelessness and require strategic interventions. In creating a plan, the Cape joined a national partnership that now includes more than 600 communities partnered in 350 10-year plans.

The plan has worked. Innovative initiatives, including Housing First and better street engagement strategies, have reduced numbers overall. And the political leadership of Barnstable County Commissioner Mary LeClair, State Sen. Robert O'Leary and then—Rep. Shirley Gomes has ensured that the plan is a living document that produces visible and measurable outcomes.

Overall, homelessness, including street and chronic homelessness, is down, according to the data.

Second, the Cape has received record resources from Washington for five consecutive years. The Cape received more than $1.2 million this past year, and more than $6 million in the past five years targeted to homeless people. That does not include the recent $2 million federal Health and Human Services grant to Duffy Health Center. And on the way are federal Neighborhood Stabilization resources to respond to the mortgage/foreclosure crisis.

Third, the Cape is blessed with agencies that are sophisticated, business minded and steeped in extraordinary expertise for our poorest neighbors. To name just two, both the Housing Assistance Corporation and Duffy Health Center are in the forefront of state non-profits assuring that resources are not simply servicing homelessness, but solving it.

Fourth, the Cape has pragmatic and resourceful political leadership that committed to a partnership that moves beyond simply managing the crisis and maintenancing past efforts to investing in solutions.

To their credit, agencies and public servants on the Cape have familiarized themselves with the innovative initiatives that are field-tested and evidenced-based. That is, they have an appetite for what works elsewhere and what is confirmed to work through the data and research. They have indicated their openness to inviting to the Cape those who have created results in reductions in similar communities, and journeying to see what works in other resort locations.

Perhaps most importantly, they have indicated an intent to engage business leadership to move beyond the demoralization, frustrations and failed policies of the past to the "remoralization" that comes through investments in a strategic plan that creates results.

A new emphasis on speaking the vernacular of the business community and practicing business principles begins with the economics of homelessness. Cost studies play a role in that reframed business mind, set to solve rather than manage. While there are many costs associated with the disabled and vulnerable homeless people who randomly ricochet through expensive health and law enforcement systems, we need only look at the situation in the Cape Cod Hospital emergency room to understand the impact.

During a recent visit there I learned that, at minimum, 10 homeless people a day enter that ER. The average cost of an emergency room visit in our nation is $1,000, exclusive of ambulance and hospital admission. Over the course of a year, then, the hospital is providing more than $3.6 million of mostly uncompensated care to homeless people who have no insurance and no means to pay.

That kind of cost analysis, done in 65 cost studies in 10-Year Plans across our country, reveals the true cost of managing homelessness. Those studies, which include hospital, addiction and mental health treatment, police and firefighter interventions on the street, court and incarceration expenses, tell us that the cost of that random ricocheting ranges between $35,000 and $150,000 per person per year, year after year.

Whereas the cost to provide a place to live, a room or efficiency and support services to stabilize the tenancies ranges from $13,000 to $25,000 a year. You don't need to be Warren Buffett to figure out which is the better investment.

We've learned that ad hoc, uncoordinated crisis interventions are more expensive and less effective. Often the same folk are cycling through systems over and over again. Just ask the doctors and nurses at the Cape Cod Hospital. To the credit of the CEO, the administration, and doctors and nurses, they are offering quality care on the front lines of homelessness every single day. So are librarians and police and treatment centers and business owners.

When we see the same people ricocheting through community services over and over again, we deserve to be frustrated. Isn't the intent to resolve and remedy homelessness rather than shuffling and cycling our poorest neighbors? Business and tourist interests, as well as hospitals, treatment, and law enforcement institutions, have a right to an answer.

That's why the current situation in downtown Hyannis offers an opportunity to open up the Cape's 10-Year Plan and refine the strategies to address the current situation. The plan is making a difference already, but a recalibration will fine-tune strategies to respond to the current dilemma and examine issues of geographic fair share and fellow resort community responses.

Here are steps that have worked in other communities:

1. Name a highly respected political leader on the Cape to reconvene the 10-Year Plan for recalibration. Find an interested and visible person from the business community to serve as Plan "champion."

2. Convene all stakeholders, including government, business and faith communities, hospital administrators, agency heads, police, librarians, and providers in high level meetings that are few and focused. The intent is strategies to recalibrate the 10-Year Plan with a priority on resolving the situation in downtown Hyannis within 90 days of plan completion.

3. Arrange for a visit of representatives from other resort communities of similar circumstances who have reduced numbers and improved quality of life.

4. Pilgrimage to resort communities that have faced the same issues and found ways to resolve them. Business and government leaders as well as providers should go. Philanthropic and foundation resources have funded such visits, and the United States Interagency Council has coordinated the itinerary and facilitated the meetings.

5. Finalize recalibration of the 10-Year Plan, including insights and innovations that are field tested and evidence based that have worked elsewhere, and monitor the implementation to ensure the strategy moves from good intentions to visible and measurable results.

The business mind set, oriented to engaging a seemingly intractable problem and finding the innovative solutions, is essential. While words of frustration are understandable, actions in partnership will create results.

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